Provider Demographics
NPI:1275675415
Name:FLUSTY, RICHARD A (PC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:FLUSTY
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30838 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6856
Mailing Address - Country:US
Mailing Address - Phone:586-777-1030
Mailing Address - Fax:586-777-6535
Practice Address - Street 1:30838 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6856
Practice Address - Country:US
Practice Address - Phone:586-777-1030
Practice Address - Fax:586-777-6535
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E05164Medicare ID - Type Unspecified